Sarcoma: Adult Soft Tissue Cancer

What is cancer?
The body is made up of trillions of living cells. Normal body cells grow, divide into new
cells, and die in an orderly way. During the early years of a person's life, normal cells divide
faster to allow the person to grow. After the person becomes an adult, most cells divide only
to replace worn-out or dying cells or to repair injuries.
Cancer begins when cells in a part of the body start to grow out of control. There are many
kinds of cancer, but they all start because of out-of-control growth of abnormal cells.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells
continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into)
other tissues, something that normal cells cannot do. Growing out of control and invading
other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its
actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the
cell dies. In cancer cells, the damaged DNA is not repaired, but the cell doesnt die like it
should. Instead, this cell goes on making new cells that the body does not need. These new
cells will all have the same damaged DNA as the first cell does.
People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen
while the normal cell is reproducing or by something in our environment. Sometimes the
cause of the DNA damage is something obvious, like cigarette smoking. But often no clear
cause is found.
In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate
through other tissues where they grow.
Cancer cells often travel to other parts of the body, where they begin to grow and form new
tumors that replace normal tissue. This process is called metastasis. It happens when the
cancer cells get into the bloodstream or lymph vessels of our body.

No matter where a cancer may spread, it is always named for the place where it started. For
example, breast cancer that has spread to the liver is still breast cancer, not liver cancer.
Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone
cancer.
Different types of cancer can behave very differently. For example, lung cancer and breast
cancer are very different diseases. They grow at different rates and respond to different
treatments. That is why people with cancer need treatment that is aimed at their particular
kind of cancer.
Not all tumors are cancerous. Tumors that arent cancer are called benign. Benign tumors can
cause problems they can grow very large and press on healthy organs and tissues. But
they cannot grow into (invade) other tissues. Because they cant invade, they also cant
spread to other parts of the body (metastasize). These tumors are almost never lifethreatening.

What is a soft tissue sarcoma?

A sarcoma is a type of cancer that develops from certain tissues, like bone or muscle. There
are 2 main types of sarcoma: bone sarcomas and soft tissue sarcomas. Soft tissue sarcomas
can develop from soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep
skin tissues. They can be found in any part of the body. Most of them develop in the arms or
legs. They can also be found in the trunk, head and neck area, internal organs, and the area in
back of the abdominal cavity (known as the retroperitoneum). Sarcomas are not common
tumors, and most cancers are the type of tumors called carcinomas.
There are many types of soft tissue tumors, and not all of them are cancerous. When a tumor
is not cancerous, it is called benign. When the term sarcoma is part of the name of a disease,
it means the tumor is malignant (cancer). There are about 50 different types of soft tissue
sarcomas (not all are listed here).
This document is about soft tissue sarcomas in adults. Sarcomas occurring in bone, such as
osteosarcomas and Ewing Family of Tumors are discussed in separate documents.
Rhabdomyosarcoma, the most common type of soft tissue sarcoma seen in children, is also
discussed in another document.

Fat tissue tumors

Benign fat tissue tumors
Lipomas are benign tumors of fat tissue. They are the most common benign soft tissue
tumor. Most are found just under the skin, but they can develop anywhere in the body.
Lipoblastomas are benign fat tumors that occur in infants and young children.

Hibernomas, like lipomas, are also benign fat tissue tumors. They are much less common
than lipomas.

Cancerous fat tissue tumors

Liposarcomas are malignant tumors of fat tissue. They can develop anywhere in the body,
but they most often develop in the thigh, behind the knee, and inside the back of the
abdomen. They occur mostly in adults between 50 and 65 years old.

Muscle tissue tumors

There are 2 types of muscle: smooth and skeletal.
Smooth muscle is found in internal organs such as stomach, intestines, blood vessels, or
uterus (womb) and causes them to contract. These muscles are involuntary we dont
control their movement.
Skeletal muscle is sometimes called striated (because stripes can be seen inside the cells
under the microscope). This is the type of muscle that lets us move our arms and legs and
other body parts when we want them to move this is called voluntary movement.

Benign muscle tumors

Leiomyomas are benign tumors of smooth muscle. Leiomyomas can start from the walls of
blood vessels, so they can develop almost anywhere in the body. They can be found in both
men and women, but the most common place to find a leiomyoma is in the walls of the
uterus. They are often called fibroids.
Rhabdomyomas are rare benign tumors of skeletal muscle.

Malignant muscle tumors

Leiomyosarcomas are malignant tumors of smooth muscle. Like leiomyomas, they can grow
almost anywhere in the body. They are most often found in the retroperitoneum (area in back
of the abdominal cavity), the internal organs, and blood vessels. These tumors are less often
found in the deep soft tissues of the legs or arms. They tend to occur in adults, particularly
the elderly. Leiomyosarcomas of the uterus are discussed in detail in our document, Uterine
Sarcoma.
Rhabdomyosarcomas are malignant tumors of skeletal muscle. These tumors commonly
grow in the arms or legs, but they can also begin in the head and neck area and in
reproductive and urinary organs like the vagina or bladder. Children are affected much more
often than adults. For more information, see our document, Rhabdomyosarcoma.

Peripheral nerve tissue tumors

The brain and spinal cord are parts of the central nervous system. The nerves that run
throughout the body are part of the peripheral nervous system. Tumors can start in these
peripheral nerves.

Benign nerve tumors

Neurofibromas, schwannomas (neurilemmomas), and neuromas are all benign tumors of
nerves. These tumors can occur almost anywhere in the body. Neurofibromas are very
common in people with an inherited condition called neurofibromatosis (also called von
Recklinghausen disease). Sometimes neurofibromas of very large nerves (like those in the
upper arms or neck) can become malignant.

Malignant nerve tumors

Neurofibrosarcomas, malignant schwannomas, and neurogenic sarcomas are malignant
tumors of the cells that surround a nerve. These are also called malignant peripheral nerve
sheath tumors.
Gastrointestinal stromal tumor (GIST) is a type of sarcoma that develops in the digestive
tract. It starts in the cells that control the muscles lining the stomach and intestine. These
muscles propel food through the digestive tract. GISTs are not discussed further in this
document, but are covered in detail in our document, Gastrointestinal Stromal Tumor
(GIST).

Joint tissue tumors

Our joints are surrounded by a capsule made of a tough tissue called synovium. This tissue
produces a fluid that lubricates the joint surfaces so that they move smoothly. Joint tissue
tumors can start in the synovium.

Benign joint tumors

Nodular tenosynovitis is a benign tumor of joint tissue. It is most common in the hands and
is more common in women than in men.

Malignant joint tumors

Synovial sarcoma is a malignant tumor of the tissue around joints. The most common
locations are the knee and ankle. Other sites are the shoulder and hip. This tumor is more
common in children and young adults, but it can occur in older people.

Blood and lymph vessels tumors

Benign vessel tumors
Hemangiomas are benign tumors of blood vessels. They are rather common and can affect
the skin or internal organs. They are sometimes present at birth, and some disappear without
treatment.
Lymphangiomas are benign lymph vessel tumors that are usually present at birth. Lymph is
a fluid that circulates in every tissue of the body, ending up in the venous system. It carries
waste products from tissues and immune system cells.
Glomus tumors are benign tumors that are found around blood vessels (perivascular). They
usually are found under the skin of the fingers.

Intermediate vessel tumors

Hemangiopericytoma is another tumor of perivascular tissue. This tumor can be either
benign or malignant. It most often starts in the legs, pelvis, and retroperitoneum (the back of
the abdominal cavity). It is most common in adults. This type of tumor usually doesn't spread
to distant sites, but it does tend to come back in or near the same place that it started, even if
it was removed completely at surgery.
Hemangioendothelioma is a blood vessel tumor that is considered a low-grade cancer
(meaning it grows slowly and is slow to spread). It does grow into nearby tissues and
sometimes can spread to distant parts of the body (metastasize). It may start in soft tissues or
in internal organs, such as the liver or lungs.

Malignant vessel tumors

Angiosarcoma is a malignant tumor that can develop either from blood vessels
(hemangiosarcomas) or from lymph vessels (lymphangiosarcomas). These tumors are linked
to radiation exposure they sometimes start in a part of the body that has been treated with
radiation. Angiosarcomas are sometimes seen in the breast after radiation therapy for breast
cancer, and in limbs that are chronically swollen because lymph circulation is blocked
(lymphedema).
Kaposi sarcoma is a cancer formed by cells similar to those lining blood or lymph vessels.
In the past, Kaposi sarcoma was an uncommon cancer mostly seen in older people who had
no apparent immune system problems. But it is now seen more often in people with
suppressed immune systems (from HIV infection and organ transplants). It is not discussed
further in this document, but is covered in detail in our document, Kaposi Sarcoma.

Fibrous tissue tumors

Fibrous tissue forms tendons and ligaments and covers bones as well as other organs in the
body.

Benign fibrous tumors

These include:
Fibromas
Elastofibromas
Superficial fibromatosis
Fibrous histiocytomas

Intermediate fibrous tumors

Fibromatosis is the name given to fibrous tissue tumor with features in between
fibrosarcoma and benign tumors such as fibromas and superficial fibromatosis. They tend to
grow slowly but, often, steadily. These tumors are also called desmoid tumors, as well as the
more scientific name musculoaponeurotic fibromatosis. They do not spread to distant sites,
but they do cause problems by growing into nearby tissues. They can sometimes be fatal.
Some doctors consider them a type of low-grade fibrosarcoma; but others believe they are a
unique type of fibrous tissue tumors. Certain hormones, particularly estrogen, make some
desmoid tumors grow. Anti-estrogen drugs are sometimes useful in treating desmoids that
cannot be completely removed by surgery.
Dermatofibrosarcoma protuberans is a slow-growing cancer of the fibrous tissue beneath
the skin, usually in the trunk or limbs. It grows into nearby tissues but rarely spreads to
distant sites.

Malignant fibrous tumors

Fibrosarcoma is cancer of fibrous tissue. It usually affects the legs, arms, or trunk. It is most
common in people between the ages of 20 and 60, but can occur at any age, even in infancy.

Uncertain tissue type tumors

Doctors look at tumor tissue under the microscope and do other tests and can usually find
similarities between most sarcomas and certain types of normal soft tissues. But some
sarcomas have not been linked to a specific type of normal soft tissue.

Benign uncertain tissue type tumors

Myxoma is a benign tumor that usually is located in muscles but does not start from muscle
cells. The cells of a myxoma produce mucus-like material, a feature that distinguishes this
tumor. It almost always occurs in adults.
Granular cell tumors are usually benign tumors in adults that occur often in the tongue but
can be found almost anywhere in the body.
PEComa is a family of tumors made up of abnormal cells called perivascular epithelial
cells. Although most of these tumors are benign, some rare PEComas are malignant (cancer).
The most common PEComas are angiomyolipoma and lymphangioleiomyomatosis (LAM).
Angiomyolipoma is a benign tumor that most often affects the kidney. LAM is a disease of
women in which the tumor cells grow into the lung tissue and interfere with lung function.

Malignant uncertain tissue type tumors

Malignant mesenchymoma is a rare type of sarcoma that has some areas showing features
of fibrosarcoma and other areas with features of at least 2 other types of sarcoma.
Alveolar soft-part sarcoma is a rare cancer that mostly affects young adults. These tumors
most commonly occur in legs.
Epithelioid sarcoma most often develops in tissues under the skin of the hands, forearms,
feet, or lower legs. Adolescents and young adults are often affected.
Clear cell sarcoma is a rare cancer that often develops in tendons of the arms or legs. Under
the microscope, it has some features of malignant melanoma, a type of cancer that develops
from pigment-producing skin cells. How cancers with these features start in parts of the body
other than the skin is not known.
Desmoplastic small round cell tumor is a rare sarcoma of adolescents and young adults,
found most often in the abdomen. Its name means that it is formed by small, round cancer
cells surrounded by scar-like tissue.
Pleomorphic undifferentiated sarcoma, also known as malignant fibrous histiocytoma
(MFH), is most often found in the arms or legs. Less often, it can start inside the back of the
abdomen. This sarcoma is most common in older adults. Although it mostly tends to grow
locally, it can spread to distant sites.
Spindle cell tumor and spindle cell sarcoma are named based on the long, narrow
appearance of the cells under the microscope). A spindle cell tumor is a tumor with cells that
look like these. Spindle cell tumor is not a specific diagnosis or a specific type of cancer. The
tumor may be a sarcoma, or it can be sarcomatoid meaning another type of tumor (like a
carcinoma) that looks like a sarcoma under the microscope.

Other types of sarcoma

There are other types of tumors called soft tissue sarcomas, but these are all quite rare.

Tumor-like conditions of soft tissue

Some conditions of soft tissues are caused by inflammation or injury and can form a mass
that looks like a soft tissue tumor. Unlike a true tumor, they do not come from a single
abnormal cell, they have limited capacity to grow or spread to nearby tissues, and never
spread through the bloodstream or lymph system. Nodular fasciitis and myositis ossificans
are 2 examples which affect tissues under the skin and muscle tissues, respectively.

What are the key statistics about soft tissue

sarcomas?
The American Cancer Society's estimates for soft tissue sarcomas in the United States for
2014 are (these statistics include both adults and children):
About 12,020 new soft tissue sarcomas will be diagnosed (6,550 cases in males and 5,470
cases in females).
4,740 Americans (2,550 males and 2,190 females) are expected to die of soft tissue
sarcomas.
The most common types of sarcoma in adults are malignant fibrous histiocytoma,
liposarcoma, and leiomyosarcoma. Certain types occur more often in certain areas of the
body than others. For example, leiomyosarcomas are the most common abdominal sarcoma,
while liposarcomas and malignant fibrous histiocytomas are most common in legs. But
pathologists (doctors who specialize in diagnosing cancers by how they look under the
microscope), may not always agree on the exact type of sarcoma. Sarcomas of uncertain type
are very common.

What are the risk factors for soft tissue

sarcomas?
A risk factor is anything that changes your chance of getting a disease like cancer. Different
cancers have different risk factors. For example, unprotected exposure to strong sunlight is a
risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, and many other
cancers. But risk factors dont tell us everything. Having a risk factor, or even several,
doesnt mean that you will get the cancer. Also, many people get cancer without having a
risk factor.

Scientists have found a few risk factors that make a person more likely to develop soft tissue
sarcomas.

Radiation exposure
Patients might develop sarcomas from radiation given to treat other cancers, like breast
cancer or lymphoma. The sarcoma often starts in the area of the body that had been treated
with radiation. The average time between radiation exposure and diagnosis of a sarcoma is
about 10 years. Radiation exposure accounts for less than 5% of sarcomas.
Radiation therapy techniques have improved steadily over several decades. Treatments now
target the cancers more precisely, and more is known about selecting radiation doses. These
advances are expected to reduce the number of cancers caused by radiation therapy. But
because these cancers take so long to develop, the results of these changes may not be seen
for a long time. Still, radiation therapy is used only when its benefits (improved survival rate
and relief of symptoms) outweigh the risk of cancer and other complications. For more
information, see our document Second Cancers Caused by Cancer Treatment.

Genetic syndromes
Certain inherited conditions increase a person's risk of developing soft tissue sarcomas.

Neurofibromatosis
Neurofibromatosis is a disease that usually runs in families and is characterized by many
neurofibromas (benign tumors that form in nerves under the skin and in other parts of the
body). It is also known as von Recklinghausen disease. It is caused by a defect (mutation) in
a gene called NF1. About 5% of people with neurofibromatosis will develop a malignant
peripheral nerve sheath tumor in a neurofibroma.

Gardner syndrome
Gardner syndrome is a disease caused by defects in the APC gene. People with this syndrome
get many polyps in the colon (and intestines) and have a high risk of getting colon cancer. It
also causes musculoaponeurotic fibromatosis (also called desmoid tumors). Some experts
consider desmoid tumors a slow-growing (low-grade) type of fibrosarcoma.

Li-Fraumeni syndrome
Li-Fraumeni syndrome is caused by inherited defects in the TP53 gene. People affected by
this syndrome have a high risk of cancer, such as breast cancer, brain tumors, and sarcomas.
People with this syndrome are sensitive to the cancer-causing effects of radiation if their

cancer is treated with radiation, they have a very high chance of developing a new cancer in
the part of the body that received the radiation.

Retinoblastoma
Retinoblastoma is an eye cancer in children that can be caused by defects in the RB1 gene.
Children with one of these gene defects also have a higher risk of developing bone or soft
tissue sarcomas, especially if treated for cancer with radiation.

Werner syndrome
Werner syndrome is caused by defects in the RECQL2 gene. Children with this syndrome
have problems like those seen in the elderly. These include cataracts, skin changes, and
clogged heart arteries (arteriosclerosis) which can lead to heart attacks. They also have an
increased risk of cancer, including soft tissue sarcomas.

Gorlin syndrome
Gorlin syndrome, also called nevoid basal cell carcinoma syndrome, is caused by defects in
the PTCH1 gene. People with this syndrome have a high risk of developing many basal cell
skin cancers. They also have an increased risk of getting fibrosarcoma and
rhabdomyosarcoma.

Tuberous sclerosis
Tuberous sclerosis can be caused by a defect in the TSC1 gene. It can also be caused by a
defect in another gene: TSC2. People with this syndrome often have seizures and learning
problems. They get benign tumors in many different organs. They also get kidney problems,
often along with a kidney tumor called angiomyolipoma. People with tuberous sclerosis have
an increased risk of getting rhabdomyosarcoma.

Damaged lymph system

Lymph is a clear fluid containing immune system cells that is carried throughout the body by
a series of lymph vessels. These vessels connect lymph nodes (small bean-shaped collections
of immune system cells). When lymph nodes have been removed by surgery or damaged by
radiation therapy, lymph fluid can build up. This is called lymphedema.
Lymphangiosarcoma (a malignant tumor that develops in lymph vessels) is a very rare
complication of chronic lymphedema.

Chemicals
Exposure to vinyl chloride (a chemical used in making plastics) is a risk factor for
developing sarcomas of the liver, but it has not been proven to cause soft tissue sarcomas.
Arsenic has also been linked to a type of liver sarcoma but not soft tissue sarcoma. Exposure
to dioxin and to herbicides that contain phenoxyacetic acid at high doses (such as might
occur to people who work on farms) may also be risk factors, but this is not known for
certain. There is no evidence that herbicides (weed killers) or insecticides, at levels
encountered by the general public, cause sarcomas.

Injury
An injury is not a risk factor for developing sarcomas. But this issue has caused some
confusion in the past. One reason is that injury may produce a swelling that resembles a
tumor but is not a true tumor. Also, when you are injured, the pain may draw your attention
to the injured area. The area may be examined closely, and x-rays or other imaging studies
may be obtained. This can make it more likely that any sarcoma that is present will be
discovered, even though it may have been present for some time.

Do we know what causes soft tissue

sarcomas?
Scientists still don't know exactly what causes most cases of soft tissue sarcoma, but they
have found several risk factors that can make a person more likely to develop these cancers.
And research has shown that some of these risk factors affect the DNA of cells in the soft
tissues.
Researchers have made great progress in understanding how certain changes in DNA can
cause normal cells to become cancerous. Our DNA carries the instructions for nearly
everything our cells do. We usually look like our parents because they are the source of our
DNA. However, DNA affects more than the way we look.
The DNA is divided into units called genes. Genes carry the recipes for making proteins, the
molecules that determine all cell functions. Some genes contain instructions for proteins that
control when our cells grow and divide.
Certain genes that promote cell division are called oncogenes. Others that slow down cell
division or cause cells to die at the right time are called tumor suppressor genes. Cancers can
be caused by DNA mutations (defects) that turn on oncogenes or turn off tumor suppressor
genes.
Several familial cancer syndromes have been found in which inherited DNA mutations cause
a very high risk of developing breast, colon, kidney, eye, or other cancers. In some of these,
there is also an increased risk of developing soft tissue sarcomas. Researchers have

characterized many of these DNA changes in the past few years. To learn more about
inherited genetic conditions, see Family Cancer Syndromes.
Some inherited conditions that increase a person's risk of developing soft tissue sarcoma
were noted in the section on risk factors. They are caused by defects (mutations) in genes that
can be inherited from a parent. These gene defects can be found through genetic testing. For
more on this topic, see Genetic Testing: What You Need to Know.
DNA mutations in soft tissue sarcoma are common. They are usually acquired during life
rather than having been inherited before birth. Acquired mutations may result from exposure
to radiation or cancer-causing chemicals. In most sarcomas, they occur for no apparent
reason.
Researchers still do not know why most soft tissue sarcomas develop in people who have no
apparent risk factors.

Can soft tissue sarcomas be prevented?

The only way to prevent some soft tissue sarcomas is to avoid exposure to risk factors
whenever possible. Most sarcomas, however, develop in people with no known risk factors,
so there is no way known at this time to prevent most cases. And for people receiving
radiation therapy, there is usually little choice.

Can soft tissue sarcomas be found early?

People who have a strong family history of sarcomas or who have had other cancers when
they were young, might wish to discuss the benefits and disadvantages of genetic testing with
their doctor. The test results should always be explained by a genetic counselor or a specially
trained doctor who can interpret the results and advise high-risk patients about early cancer
detection.
Families with a history of certain inherited conditions (see the section, What are the risk
factors for soft tissue sarcomas?) caused by mutated tumor suppressor genes have an
increased risk of developing soft tissue sarcomas. The mutated genes can be detected by
genetic testing, so family members should discuss this option with their doctors. They should
let their doctor know about any lumps or growths right away.
No screening tests and exams are recommended for people who have no family history of
sarcoma or other sarcoma risk factors. For these people, the best approach to early detection
is to tell their health care professional about any unexplained lumps or growths or other
symptoms that may be caused by a soft tissue sarcoma.

Signs and symptoms of soft tissue sarcomas

More than half of sarcomas begin in an arm or leg. Most people simply notice a lump that
has grown over a period of time (weeks to months). Although the lump is often not painful,
in some cases it will hurt.
When sarcomas grow in the retroperitoneum (the back wall inside the abdomen), the
symptoms they cause more often come from other problems. Sometimes the tumors cause
pain. They may also cause blockage or bleeding of the stomach or bowels. They may grow
large enough for the tumor to be felt in the abdomen. About 20% of sarcomas begin in the
abdomen (stomach) area.
Sarcomas can also begin on the outside of the chest or abdomen (about 10%) or in the head
or neck area (around 10%).
If you have any of the following problems, see a doctor right away:
A new lump or a lump that is growing anywhere on your body
Abdominal pain that is getting worse
Blood in your stool or vomit
Black, tarry stools (when bleeding happens in the stomach or bowels, the blood can turn
black as it is digested, and it may make the stool very black and sticky)
These symptoms are more often caused by things other than sarcoma, but they still need to be
checked out by a doctor.

How are soft tissue sarcomas diagnosed?

If you have signs or symptoms or other reasons to suggest you might have a sarcoma, your
doctor will talk with you, examine you, and probably need to order some tests to find out if
cancer is really present.

Medical history and physical exam

Your doctor will take a complete medical history to check for any risk factors and to ask you
about symptoms, as well as any other medical conditions. They will also examine you for
signs of sarcomas and other health problems.

Imaging tests
Some tests, such as a computed tomography (CT) scan or a magnetic resonance imaging
(MRI) scan, are often done to look for the cause of symptoms and to find a tumor (such as a
sarcoma). Other tests may be done after a sarcoma is diagnosed to look for cancer spread.

Plain x-ray
A regular x-ray of the area with the lump may be the first test ordered. A plain chest x-ray
may be done after diagnosis to look for spread of sarcoma to the lungs.

Computed tomography scans

The CT scan is an x-ray procedure that produces detailed, cross-sectional images of your
body. Instead of taking one picture like a conventional x-ray, a CT scanner takes many
pictures as it rotates around you. A computer then combines these pictures into an image of a
slice of your body. The machine will create multiple images of the part of your body being
studied. A CT scan is often done if the doctor suspects a soft tissue sarcoma in the chest,
abdomen, or the retroperitoneum. This test is also used to see if the sarcoma has spread into
the lungs, liver or other organs.
A CT scanner has been described as a large donut, with a narrow table in the middle opening.
You will need to lie still on the table while the scan is being done. CT scans take longer than
regular x-rays, and you might feel a bit confined by the ring while the pictures are being
taken
Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called oral
contrast. This helps outline the intestine more clearly. You may also receive an IV
(intravenous) line through which a different kind of contrast dye (IV contrast) is injected.
This helps better outline structures in your body.
The IV contrast dye can also cause some flushing (redness and warm feeling). Some people
are allergic and get hives or, rarely, more serious reactions like trouble breathing and low
blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast
material used for x-rays.
CT scans might be done to precisely guide a biopsy needle into a tumor that is inside the
body the chest or abdomen, for example. For this procedure, called a CT-guided needle
biopsy, the patient remains on the CT scanning table while a radiologist advances a biopsy
needle toward the location of the mass. CT scans are repeated until the doctors are sure the
needle is within the mass.

Magnetic resonance imaging scans

Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of xrays to take pictures of the body. The energy from the radio waves is absorbed and then
released in a pattern formed by the type of tissue and by certain diseases. A computer
translates the pattern of radio waves given off by the tissues into a very detailed image of
parts of the body. A contrast material might be injected, just as with CT scans, but is used
less often.
MRI scans are often part of the work-up of any tumor that could be a sarcoma. They are
often better than CT scans in evaluating sarcomas in the arms or legs. They provide a good
picture of the extent of the tumor. They can show your health care team many things about
the tumor, including location, size, and sometimes even the type of tissue it comes from (like
fat or muscle). This makes MRI scans useful in planning a biopsy.
MRIs are also very helpful in examining the brain and spinal cord.
MRI scans are a little more uncomfortable than CT scans. First, they take longer often up
to an hour. Also, you have to lie inside a long tube, which is confining and can be upsetting.
Special "open" MRI machines sometimes are an option for people who have claustrophobia
(fear of enclosed spaces), but the drawback is that the pictures are often not as clear. MRI
machines also make a thumping noise that you may find disturbing. Some places will provide
headphones with music to block this noise out.

Ultrasound
Ultrasound uses sound waves and their echoes to produce pictures of parts of the body. A
small instrument called a transducer emits sound waves and picks up the echoes as they
bounce off the organs. The sound wave echoes are converted by a computer into an image
that is displayed on a computer screen.
This is a very easy procedure to have. It uses no radiation, which is why it is often used to
look at developing fetuses. For most ultrasounds, you simply lie on a table while a technician
moves the transducer over the part of your body being examined. Usually, the skin is first
lubricated with gel. This test may be done before a biopsy to see if the lump is a cyst,
meaning it contains fluid and is likely benign, or if it is solid and more likely a tumor. This
test is often not needed if a CT or MRI was done.

Positron emission tomography scan

In this test, radioactive glucose (sugar) is injected into the patient's vein to look for cancer
cells. Because cancers use glucose (sugar) at a higher rate than normal tissues, the
radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive
deposits. A positron emission tomography (PET) scan is useful when your doctor thinks the
cancer has spread but doesn't know where. A PET scan can be used instead of several

different x-rays because it scans your whole body. Often the PET scan is used with a CT
scan. This helps decide if abnormalities seen on the CT scan are cancer or something else.
PET is not often used for sarcoma, but it can be helpful in certain cases.

Biopsy
A biopsy is a procedure that removes a sample of tissue from a tumor to see if it is a type of
cancer. The piece of tissue is looked at under a microscope and, some other tests may be
done on the sample as well. A physical exam or imaging test may suggest that a tumor is a
sarcoma, but a biopsy is the only way to be certain that it is a sarcoma and not another type
of cancer or a benign disease.
Several types of biopsies are used to diagnose sarcomas. Doctors with experience in these
tumors will choose one, based on the size and location of the tumor. Most experts prefer a
fine needle aspiration or a core needle biopsy as the first step.

Fine needle aspiration (FNA) biopsy

In FNA, the doctor uses a very thin needle and a syringe to withdraw small pieces of tissue
from the tumor mass. The doctor can often aim the needle while feeling the mass near the
surface of the body. If the tumor is too deep to feel, the doctor can guide the needle while
viewing a computed tomography (CT) scan. The main advantage of FNA is that it can be
used to biopsy tumors deep in the body without surgery. The disadvantage is that the thin
needle may not remove enough tissue to make a precise diagnosis.
FNA is often useful in showing that a mass first thought to be a sarcoma (found on physical
exam or imaging tests) is really another type of cancer, a benign tumor, an infection, or some
other disease. But if FNA results suggest a sarcoma, another type of biopsy will usually be
done to remove enough tissue to confirm that diagnosis. After a sarcoma is diagnosed, FNA
is most useful in determining whether additional tumors in other organs are metastases.

Core needle biopsy

Core needle biopsies use a needle that is larger than the FNA needle. Sometimes this needle
is called a Tru-Cut needle. It removes a cylindrical piece of tissue about 1/16 inch across and
1/2 inch long. It usually removes enough tissue to see if a sarcoma is present. Like FNA, CT
scans can be used to guide the needle into tumors of internal organs.

Surgical biopsy
In a surgical biopsy, the entire tumor or a piece of the tumor is removed during an operation.
There are 2 types of surgical biopsies, excisional and incisional. In an excisional biopsy, the
surgeon removes the entire tumor. In an incisional biopsy, only a piece of a large tumor is
removed. An incisional biopsy almost always removes enough tissue to diagnose the exact
type and grade of sarcoma. If the tumor is near the skin surface, this is a simple operation that

can be done with local or regional anesthesia (numbing medication given near the mass or
into a nerve). But if the tumor is deep inside the body, general anesthesia is used (the patient
is asleep).
If a tumor is rather small, near the surface of the body, and not located near critical tissues
(such as important nerves or large blood vessels), the doctor may choose to remove the entire
mass and a margin of normal tissue in an excisional biopsy. This surgery combines the
biopsy and the treatment into one operation, so it should only be done by a surgeon with
experience in treating sarcomas.
If the tumor is large, then an incisional biopsy is needed. Only a surgeon experienced in
sarcoma treatment should perform this procedure.
You might want to ask about your surgeons experience with this procedure. Proper biopsy
technique is a very important part of successfully treating soft tissue sarcomas. An improper
biopsy can lead to tumor spread and problems removing the tumor later on. An incisional
biopsy in the wrong place or an excision without wide enough margins can make it harder to
completely remove a sarcoma later on. To prevent these problems, these 2 types of biopsies
should only be done by a surgeon experienced in treating sarcomas. It is best that an
incisional biopsy be done by the same surgeon who will later remove the entire tumor (if a
sarcoma is found).

Testing biopsy samples

The tissue removed will be looked at under the microscope to see if cancer is present. If
cancer is present, the doctor will try to determine what kind it is (sarcoma or carcinoma.
Grading: If a sarcoma is present, the biopsy will be used to determine what type it is and its
grade. The grade of a sarcoma is based on how the cancer cells look under the microscope. In
grading a cancer, the pathologist (a doctor who specializes in diagnosing diseases by looking
at the tissue under a microscope) considers how closely the tumor resembles normal tissue
(differentiation), how many of the cells appear to be dividing, and how much of the tumor is
made up of dying tissue.
Each factor is given a score, and the scores are added to determine the grade of the tumor.
Sarcomas that have cells that look more normal and have fewer cells dividing are generally
placed in a low-grade category. Low-grade tumors tend to be slow growing, slower to spread,
and often have a better outlook (prognosis) than higher-grade tumors. Certain types of
sarcoma are automatically given higher scores for differentiation. This affects the overall
score so much that they are never considered low grade. Examples of these include synovial
sarcomas and embryonal sarcomas.
The grade is partly used to determine the stage of a sarcoma. The official staging system (see
the section, How are soft tissue sarcomas staged?) divides sarcomas into 3 grades (1 to 3).
The grade of a sarcoma helps predict how rapidly it will grow and spread. It is useful in
predicting a patient's outlook and helps determine treatment options.

Immunohistochemistry: Sometimes these special tests are needed to accurately determine

whether a sarcoma is present and, if so, what type. Part of the biopsy sample is treated with
special man-made antibodies that recognize cell proteins typical of certain kinds of sarcomas.
The cells are treated with chemicals that make the cells containing the specific proteins
change color. The color change is then seen under a microscope.
Cytogenetics: For this test, cells' chromosomes are examined with a microscope to look for
changes. For example, in certain types of sarcomas part of one chromosome may be
abnormally attached to part of a different chromosome (called a translocation). To see the
chromosomes clearly, the cancer cells usually must be grown in laboratory flasks for at least
a week.
Fluorescent in situ hybridization (FISH) can sometimes be used to detect translocations
and other chromosome changes without first growing the cells in the lab. Tests of
chromosome changes are not required to diagnose most sarcomas, but they are sometimes
very useful. And as new changes are discovered, these tests may become more important and
more common.
Reverse transcription polymerase chain reaction (RT-PCR): This test is another way to
find translocations in some sarcomas (such as the Ewing family of tumors, alveolar
rhabdomyosarcoma, and synovial sarcoma) to confirm the type of tumor. Instead of using a
microscope to look for the chromosome changes as in cytogenetic testing or FISH, RT-PCR
uses chemical analysis of the RNA (a substance that is made from DNA) from genes affected
by the translocation. RT-PCR testing is often able to find translocations that aren't detected
by cytogenetics.

How are soft tissue sarcomas staged?

The process of finding out how far the cancer has spread is called staging. In sarcoma
staging, doctors also evaluate the appearance of the tumor under the microscope and judge
how fast the cancer seems to be growing. The stage of a sarcoma is the most significant
factor in determining each patient's prognosis (the course of the disease and the chances of
survival) and in selecting treatment options.
The information needed to stage sarcomas includes biopsies, and imaging tests of the main
tumor (usually with CT or MRI scans) other parts of the body where the cancer may have
spread.
When examining the biopsy sample, the pathologist (doctor who specializes in diagnosing
diseases by looking at the tissue under a microscope) takes into account the number of cells
that are actively dividing and how closely the cancer resembles normal tissue. He or she
determines the cell type and grade and estimates how rapidly it will grow and spread.

A staging system is a standard way for the cancer care team to summarize the extent of a
cancer's spread. The system often used to stage sarcomas is the TNM system of American
Joint Committee on Cancer.
T stands for the size of the tumor.
N stands for spread to lymph nodes (small bean-shaped collections of immune system
cells found throughout the body that help fight infections and cancers).
M is for metastasis (spread to distant organs).
In soft tissue sarcomas, an additional factor, called grade (G), is also part of the tumors
stage. The grade is based on how the sarcoma cells look under the microscope.

Grade (G)
The grade is a sign of how likely it is the cancer will spread. Previously, the grade of a
sarcoma was only based on how normal the cells looked under the microscope (called
differentiation). This was not very helpful, and under a new system (known as the French or
FNCLCC system), grade is based on 3 factors:
Differentiation cancer cells are given a score of 1 to 3, with 1 being assigned when
they look similar to normal cells and 3 being used when the cancer cells look very
abnormal
Mitotic count how many cancer cells are seen dividing under the microscope; given a
score from 1 to 3 (a lower score means fewer cells were seen dividing)
Tumor necrosis how much of the tumor is made up of dying tissue; given a score from
0 to 2 (a lower score means there was less dying tissue present).
The scores for each factor are added to determine the grade for the cancer. Higher-grade
cancers tend to grow and spread faster than lower-grade cancers.
GX: the grade cannot be assessed (because of incomplete information).
Grade 1 (G1): Total score of 2 or 3
Grade 2 (G2): Total score of 4 or 5
Grade 3 (G3): Total score of 6 or higher

Tumor (T)
T1: The sarcoma is 5 cm (2 inches) or less across
T1a: The tumor is superficial near the surface of the body.

 T1b: The tumor is deep in the limb or abdomen.

T2: The sarcoma is greater than 5 cm (2 inches) across.
T2a: The tumor is superficial near the surface of the body.
T2b: The tumor is deep in the limb or abdomen.

Lymph nodes (N)

N0: The sarcoma has not spread to nearby lymph nodes.
N1: The sarcoma has spread to nearby lymph nodes.

Metastasis (M)
M0: No distant metastases (spread) of sarcoma are found.
M1: The sarcoma has spread to distant organs or tissues (such as the lungs).

Stage grouping for soft tissue sarcomas

To assign a stage, information about the tumor, its grade, lymph nodes, and metastasis is
combined by a process called stage grouping. The stage is described by Roman numerals
from I to IV and the letters A or B. The stage is useful in selecting treatment, but other
factors, such as where the sarcoma is located, also influence treatment planning and outlook.

Stage IA
T1, N0, M0, G1 or GX: The tumor is not larger than 5 cm (2 inches) across (T1). It has not
spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 1 (or the grade
cannot be assessed).

Stage IB
T2, N0, M0, G1 or GX: The tumor is larger than 5 cm (2 inches) across (T2). It has not
spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 1 (or the grade
cannot be assessed).

Stage IIA
T1, N0, M0, G2 or G3: The tumor is not larger than 5 cm (2 inches) across (T1). It has not
spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 2 or 3.

Stage IIB
T2, N0, M0, G2: The tumor is larger than 5 cm (2 inches) across (T2). It has not spread to
lymph nodes (N0) or more distant sites (M0). The cancer is grade 2.

Stage III:
Either
T2, N0, M0, G3: It is larger than 5 cm (2 inches) across (T2). It has not spread to lymph
nodes (N0) or more distant sites (M0). The cancer is grade 3.
OR
Any T, N1, M0, any G: The cancer can be any size (any T) and any grade. It has spread to
nearby lymph nodes (N1). It has not spread to distant sites (M0).

Stage IV
Any T, Any N, M1, any G: The cancer can be any size (any T) and grade (any G). It has
spread to lymph nodes near the tumor (N1) and/or to distant sites (M1).

Survival by stage of soft tissue sarcoma

Survival rates are often used by doctors as a standard way of discussing a persons prognosis
(outlook). Some patients with cancer may want to know the survival statistics for people in
similar situations, while others may not find the numbers helpful, or may even not want to
know them. If you dont want to know them, stop reading here and go to the next section.
The 5-year survival rate (or observed survival rate) refers to the percentage of patients who
live at least 5 years after their cancer is diagnosed. Of course, many people live much longer
than 5 years (and many are cured).
Five-year relative survival rates assume that some people will die of other causes and
compare the observed survival with that expected for people without the cancer. This is a
better way to see the effect of the cancer on survival.
To get 5-year survival rates, doctors have to look at people who were treated at least 5 years
ago. If treatment has improved since then, people now being diagnosed with soft tissue
sarcoma may have a more favorable outlook.
Survival rates are often based on previous outcomes of large numbers of people who had the
disease, but they cannot predict what will happen in any individuals case. Many other
factors might affect a persons outlook, like the type of sarcoma, the location of the tumor,
the treatment received, and the age of the patient. For example, sarcomas of the arms or legs
have a better outcome than those found in other places. Also, older patients tend to have

worse outcomes than younger people. Your doctor can tell you how the numbers below may
apply to you, as he or she is familiar with your particular situation.
The rates below are based on the stage of the cancer at the time of diagnosis. When looking
at survival rates, its important to understand that the stage of a cancer does not change over
time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by
the stage it was given when it was first found and diagnosed, but more information is added
to explain the current extent of the cancer. (And the treatment plan is adjusted based on the
change in cancer status.)
The overall relative 5-year survival rate of people with soft tissue sarcomas is around 50%
according to statistics from the National Cancer Institute (NCI). These statistics include
people with Kaposi sarcoma, which has a poorer outlook than many sarcomas. The NCI
doesnt use the AJCC staging system. Instead, they group sarcomas only by whether they are
still confined to the primary site (called localized) have spread to nearby lymph nodes or
tissues (called regional); or have spread (metastasized) to sites away from the main tumor
(called distant). The 5-year survival rates for soft tissue sarcomas have not changed much for
many years. The corresponding 5-year relative survival rates were:
83% for localized sarcomas (56% of soft tissue sarcomas were localized when they were
diagnosed)
54% for regional stage sarcomas; (19% were in this stage)
16% for sarcomas with distant spread (16% were in this stage)
The 10-year relative survival rate is only slightly worse for these stages, meaning that most
people who survive 5 years are probably cured.
For sarcomas of the arms and legs, Memorial Sloan-Kettering Cancer Center has survival
rates broken down by AJCC stage (these are for observed, not relative survival):

Stage

5-year observed
survival rate

90%

II

81%

III

56%

IV

Not available

Survival is worse when the sarcoma has developed somewhere other than the arms or legs.
For example, the 5-year survival for retroperitoneal sarcomas is around 40% to 60%.

How are soft tissue sarcomas treated?

This information represents the views of the doctors and nurses serving on the American Cancer Societys
Cancer Information Database Editorial Board. These views are based on their interpretation of studies
published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as medical
advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your
family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment options.
Dont hesitate to ask him or her questions about your treatment options.

General treatment information

Experts recommend that patients with sarcoma have a health care team made up of doctors
from different specialties, such as:
An orthopedic surgeon: a surgeon who specializes in diseases of the bones, muscles, and
joints (for sarcomas of the arms and legs)
A surgical oncologist: a doctor who treats cancer with surgery (for sarcomas of the
abdomen and retroperitoneum)
A thoracic surgeon: a doctor who treats diseases of the lungs and chest with surgery
A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy
A radiation oncologist: a doctor who treats cancer with radiation therapy
A physiatrist (or rehabilitation doctor): a doctor who treat injuries or illnesses that affect
how you move
Many other specialists may be involved in your care as well, including physician assistants,
nurse practitioners, nurses, respiratory therapists, social workers, physical therapists, and
other health professionals.
After a sarcoma is found and staged, your team will recommend one or several treatment
options. This decision is important, so take time and think about all of the choices. In
choosing a treatment plan, factors to consider include the type, location, and stage of the
cancer, as well as your overall physical health.
The main types of treatment for soft tissue sarcoma are:
Surgery

 Radiation
Chemotherapy
Targeted therapy
It is important to discuss all of your treatment options, including their goals and possible side
effects, with your doctors to help make the decision that best fits your needs. Its also very
important to ask questions if there is anything youre not sure about. You can find some good
questions to ask in the section, What should you ask your doctor about soft tissue
sarcomas? It also is often a good idea to seek a second opinion. A second opinion can
provide more information and help you feel more confident about the chosen treatment plan.
Some insurance companies require a second opinion before they will agree to pay for
treatments.

Surgery for soft tissue sarcomas

Depending on the site and stage of a sarcoma, surgery might be able to remove the cancer
and some of the nearby tissue. The goal of surgery is to remove the entire tumor along with
at least 1 to 2 cm (less than an inch) of the normal tissue surrounding the tumor. This is to
make sure that no cancer cells are left behind. When the removed tissue is looked at under a
microscope, the doctor will check to see if cancer is growing in the edges (margins) of the
specimen. If cancer cells are present at the edges, the tissue removed is said to have positive
margins. This means that cancer cells may have been left behind.
When cancer cells are left after surgery, the patient may need more treatment such as
radiation or another surgery. If cancer isnt growing into the edges of the tissue removed, it is
said to have negative or clear margins. The sarcoma has much less chance of coming back
after surgery if it is removed with clear margins. When the tumor is in the abdomen,
removing the tumor with enough normal tissue to get clear margins could be difficult because
the tumor could be next to vital organs that cant be taken out.
In the past, many of the sarcomas in the arms and legs were treated by amputating
(removing) the limb. Now, amputation rarely is needed. Instead, most patients can be treated
with surgery to remove the tumor without amputation (called limb-sparing surgery). This is
usually followed by radiation therapy. These patients have the same overall survival rates as
those who have amputations.
Sometimes, an amputation cant be avoided. It might be the only way to remove all of the
cancer. Other times, critical nerves, muscles, bone, and blood vessels would have to be
removed along with the cancer. If removing this tissue would mean leaving a limb that cant
function well or result in chronic pain, amputation may be the best option.
If the sarcoma has spread to distant sites (such as the lungs or other organs), all of the cancer
will be removed if possible. That includes the original tumor plus the areas of spread. If it
isn't possible to remove all of the sarcoma, then surgery may not be done at all.

Sometimes chemotherapy (chemo), radiation, or both is given before surgery. This, called
neoadjuvant treatment, can shrink the tumor and allow it to be removed completely. Chemo
or radiation can also be given before surgery to treat high-grade sarcomas when there is a
great risk of the cancer spreading.
Most of the time, surgery cannot cure a sarcoma once it has spread. But if it has only spread
to the lung, the metastatic tumor can sometimes be removed. This can cure many patients, or
at least lead to long-term survival.
You can read more about surgery for cancer in our document, Understanding Cancer
Surgery: A Guide for Patients and Families.

Radiation therapy for soft tissue sarcomas

Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells.
Most of the time radiation is given after surgery as an added measure. This, called adjuvant
treatment, is done to kill any cancer cells that may be left behind after surgery.
Radiation may also be used before surgery to shrink the tumor and make the operation easier.
This is called neoadjuvant treatment.
Radiation can be the main treatment for sarcoma in people whose general health is too poor
to undergo surgery.
Radiation therapy can also be used to help symptoms of sarcoma when it has spread. This is
called palliative treatment.

Types of radiation therapy

External beam radiation therapy: For this treatment, radiation delivered from outside the
body is focused on the cancer. This is the type of radiation therapy most often used to treat
sarcomas. Treatments are often given daily, 5 days a week, usually for several weeks. Often a
technique called intensity modulated radiation therapy (IMRT) is used. This better focuses
the radiation on the cancer and lessens the impact on healthy tissue.
In some centers, proton beam radiation is an option. This uses streams of protons instead of
x-ray beams to treat the cancer. Although this has some advantages over IMRT in theory, it
hasnt been proven to be a better treatment for soft tissue sarcoma. Proton beam therapy is
not widely available.
Another option that is available in only a few centers is intraoperative radiation therapy
(IORT). For this treatment, one large dose of radiation is given in the operating room after
the tumor is removed but before the wound is closed. Giving radiation this way means that it
doesnt have to travel through healthy tissue to get to the area that needs to be treated. It also
allows nearby healthy areas to be shielded more easily from the radiation. Often, IORT is

only one part of radiation treatment, and the patient receives some other type of radiation
after surgery.
Brachytherapy: Brachytherapy (sometimes called internal radiation therapy) is a treatment
that places small pellets (or seeds) of radioactive material in or near the cancer. For soft
tissue sarcoma, these pellets are put into catheters (very thin tubes) that have been placed
during surgery. In high-dose rate (HDR) brachytherapy, the pellets give off a lot of radiation
in a short time, and so stay in place for only minutes at a time. In low-dose rate (LDR)
brachytherapy, the pellets may stay in place for days at a time, and then removed.
Brachytherapy may be the only form of radiation therapy used or it can be combined with
external beam radiation.

Side effects of radiation treatment

Side effects of radiation therapy depend on which area is treated and the dose given.
Common side effects include
Skin changes in the area the radiation went through the skin, which can range from
redness to blistering and peeling
Fatigue.
Nausea and vomiting (more common with radiation to the abdomen)
Diarrhea (most common with radiation to the pelvis and abdomen)
Pain with swallowing (from while radiation to the chest)
Lung damage leading to problems breathing(from radiation to the chest)
Bone weakness, which can lead to fracture years later
Radiation of large areas of an arm or leg can cause swelling, pain, and weakness in that limb.
Side effects of radiation therapy to the brain for metastatic sarcoma include hair loss,
headaches, and problems thinking.
If given before surgery, radiation may cause problems with wound healing.
Many side effects improve or even go away some time after radiation is finished. Some
though, like bone weakness and lung damage, can be permanent.
More information on this topic can be found in the Radiation section of our website, or in our
document Understanding Radiation Therapy: A Guide for Patients and Families.

Chemotherapy for soft tissue sarcomas

Chemotherapy (chemo) is the use of drugs given into a vein or taken by mouth to treat
cancer. These drugs enter the bloodstream and reach all areas of the body, making this
treatment useful for cancer that has spread (metastasized) to other organs. Depending on the
type and stage of sarcoma, chemotherapy may be given as the main treatment or as an
adjuvant (addition) to surgery. Chemotherapy for soft tissue sarcoma generally uses a
combination of several anti-cancer drugs.
The most commonly used drugs are ifosfamide (Ifex) and doxorubicin (Adriamycin).
When ifosfamide is used, the drug mesna is also given. Mesna is not a chemo drug. It
protects the bladder from the toxic effects of ifosfamide.
Other chemo drugs may be used as well, including cisplatin, dacarbazine (DTIC), docetaxel
(Taxotere), gemcitabine (Gemzar), methotrexate, oxaliplatin, paclitaxel (Taxol),
vincristine, and vinorelbine (Navelbine).
When several drugs are used together, the combination is given a shortened name such as:
MAID (mesna, doxorubicin [Adriamycin], ifosfamide, and dacarbazine).
Chemotherapy drugs kill cancer cells but also damage some normal cells. Side effects depend
on the type of drugs, the amount taken, and the length of treatment. Common chemo side
effects include:
Nausea and vomiting
Loss of appetite
Loss of hair
Mouth sores
Fatigue
Low blood counts
Because chemotherapy can damage the blood-producing cells of the bone marrow, patients
may have low blood cell counts. This can result in:
Increased chance of infection (from too few white blood cells)
Problems with bleeding or bruising (from too few blood platelets)
Fatigue and weakness (from too few red blood cells)
Most side effects disappear once treatment is stopped. Hair will grow back after treatment
ends, but it might look different. There are remedies for many of the temporary side effects
of chemotherapy. For example, drugs can be given that prevent or reduce nausea and
vomiting.

Some chemo side effects can last a long time or even be permanent. For example,
doxorubicin can weaken the heart if too much is given. If you are to be treated with this drug,
your doctor might check your heart function with special studies before starting this drug.
The doctor will also watch the dose of doxorubicin closely during therapy.
Some chemo drugs cause nerve damage (called neuropathy), leading to numbness, tingling,
or even pain in the hands and feet. To learn more about this, see our document Peripheral
Neuropathy After Chemotherapy.
Chemotherapy may also permanently damage ovaries or testicles, which can lead to
infertility (not being able to have children). This is discussed in more detail in our documents
Fertility and Women With Cancer and Fertility and Men With Cancer.
If youd like more information on a drug used in your treatment or a specific drug mentioned
in this section, see our Guide to Cancer Drugs, ask your health care team, or call us with the
names of the medicines youre taking.

Isolated limb perfusion

This procedure is a different way to give chemo. The circulation of the limb (arm or leg) with
the tumor in it is separated from that of the rest of the body. Chemo is given just to that limb.
Sometimes the blood is warmed up a bit to help the chemo work better (this is called
hyperthermia). This can help shrink tumors, but it isnt clear that it helps patients live longer
than standard chemo. It should only be done at centers with a lot of experience in giving
chemo this way.

Targeted therapy for soft tissue sarcoma

Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to
identify and attack cancer cells while doing little damage to normal cells. These therapies
attack the cancer cells' inner workings the programming that makes them different from
normal, healthy cells. Each type of targeted therapy works differently, but all alter the way a
cancer cell grows, divides, repairs itself, or interacts with other cells.

Pazopanib (Votrient)
At this time, pazopanib is the only targeted therapy drug approved to treat soft tissue
sarcoma. It blocks several cellular enzymes called tyrosine kinases that are important for cell
growth and survival. In a study of patients with advanced soft tissue sarcomas that had been
treated with chemotherapy, pazopanib stopped the cancers from growing for an average of
about 3 months longer than the patients given a sugar pill. So far, though, this drug hasnt
been shown to help patients live longer. This drug is taken in pill form, once a day.
Common side effects include high blood pressure, nausea, diarrhea, headaches, low blood
cell counts, and liver problems. In some patients this drug causes abnormal results on liver

function tests, but it also rarely leads to severe liver damage that can be life threatening.
Bleeding, clotting, and wound healing problems can occur, as well. This drug also rarely
causes a problem with the heart rhythm or even a heart attack. If you are taking pazopanib,
your doctor will monitor your heart with EKGs as well as check your blood tests to check for
liver or other problems.

Imatinib (Gleevec)
Imatinib is a tyrosine kinase inhibitor drug approved to treat gastrointestinal stromal tumors
and some kinds of leukemia. It also can be helpful in treating desmoid tumors that cant be
removed with surgery. Although it rarely causes tumors to shrink, it often causes them to
stop growing for a time, which can be very helpful.
Side effects can include mild stomach upset, diarrhea, muscle pain, and skin rashes. The
stomach upset is lessened if the drug is taken with food. Imatinib can also make people retain
fluid. Often this causes some swelling in the face (around the eyes) or in the ankles. Rarely
the drug causes more severe problems, such as fluid build up in the lungs or abdomen or
causing problems with heart function.
If youd like more information on a drug used in your treatment or a specific drug mentioned
in this section, ask your health care team, see our Guide to Cancer Drugs, or call us with the
names of the medicines youre taking.

Clinical trials for soft tissue sarcomas

You may have had to make a lot of decisions since you've been told you have cancer. One of
the most important decisions you will make is choosing which treatment is best for you. You
may have heard about clinical trials being done for your type of cancer. Or maybe someone
on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who
volunteer for them. They are done to get a closer look at promising new treatments or
procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if your
clinic or hospital conducts clinical trials. You can also call our clinical trials matching service
for a list of clinical trials that meet your medical needs. You can reach this service at 1-800303-5691 or on our website at www.cancer.org/clinicaltrials. You can also get a list of
current clinical trials by calling the National Cancer Institute's Cancer Information Service
toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials website
at www.cancer.gov/clinicaltrials.
There are requirements you must meet to take part in any clinical trial. If you do qualify for a
clinical trial, it is up to you whether or not to enter (enroll in) it.

Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be
the only way to get access to newer treatments. They are also the only way for doctors to
learn better methods to treat cancer. Still, they are not right for everyone.
You can get a lot more information on clinical trials in our document called Clinical Trials:
What You Need to Know. You can read it on our website or call our toll-free number (1-800227-2345) and have it sent to you.

Complementary and alternative therapies for soft tissue

sarcomas
When you have cancer you are likely to hear about ways to treat your cancer or relieve
symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet
groups and websites might offer ideas for what might help you. These methods can include
vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name
a few.

What exactly are complementary and alternative therapies?

Not everyone uses these terms the same way, and they are used to refer to many different
methods, so it can be confusing. We use complementary to refer to treatments that are used
along with your regular medical care. Alternative treatments are used instead of a doctor's
medical treatment.
Complementary methods: Most complementary treatment methods are not offered as cures
for cancer. Mainly, they are used to help you feel better. Some methods that are used along
with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or
peppermint tea to relieve nausea. Some complementary methods are known to help, while
others have not been tested. Some have been proven not to be helpful, and a few have even
been found harmful.
Alternative treatments: Alternative treatments may be offered as cancer cures. These
treatments have not been proven safe and effective in clinical trials. Some of these methods
may pose danger, or have life-threatening side effects. But the biggest danger in most cases is
that you may lose the chance to be helped by standard medical treatment. Delays or
interruptions in your medical treatments may give the cancer more time to grow and make it
less likely that treatment will help.

Finding out more

It is easy to see why people with cancer think about alternative methods. You want to do all
you can to fight the cancer, and the idea of a treatment with few or no side effects sounds
great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no

longer be working. But the truth is that most of these alternative methods have not been
tested and proven to work in treating cancer.
As you consider your options, here are 3 important steps you can take:
Look for "red flags" that suggest fraud. Does the method promise to cure all or most
cancers? Are you told not to have regular medical treatments? Is the treatment a "secret"
that requires you to visit certain providers or travel to another country?
Talk to your doctor or nurse about any method you are thinking about using.
Contact us at 1-800-227-2345 to learn more about complementary and alternative
methods in general and to find out about the specific methods that interest you. You can
also read about them on the Complementary and Alternative Medicine page of our
website.

The choice is yours

Decisions about how to treat or manage your cancer are always yours to make. If you want to
use a non-standard treatment, learn all you can about the method and talk to your doctor
about it. With good information and the support of your health care team, you may be able to
safely use the methods that can help you while avoiding those that could be harmful.

Treatment of soft tissue sarcomas, by stage

The only way to cure a soft tissue sarcoma is to remove it with surgery, so surgery is part of
the treatment for all soft tissue sarcomas whenever possible. It is important that your surgeon
and other doctors are experienced in the treatment of sarcomas. These are difficult tumors to
treat and require both experience and expertise. Studies have shown that patients with
sarcomas have better outcomes when they are treated at specialized cancer centers that have
experience in sarcoma treatment.

Desmoid tumors
Desmoid tumors are often not considered true cancers because they do not spread to distant
sites. The most common treatment for these tumors is surgery. If the entire tumor is removed
and the margins are clear, no other treatment is needed. These tumors can also be treated with
radiation (instead of surgery).
For tumors that are large or have come back after treatment, drug therapy may be helpful.
The drug sulindac, normally used to treat arthritis, can stop tumor growth or even cause the
tumor to shrink. It can take months for the drug to work, but its effect can last for years.
Drugs that block estrogen (tamoxifen and toremifene) have also been helpful in some
patients. Some desmoid tumors have responded to treatment with chemotherapy (chemo)
using the drug doxorubicin (Adriamycin), which may be used alone or with other drugs. The

combination of methotrexate and vinblastine has also been helpful. Interferon, an immuneboosting drug, has also been used with some success. Another option is the targeted drug
imatinib (Gleevec).

Stage I soft tissue sarcoma

Stage I soft tissue sarcomas are low-grade tumors of any size. Small (less than 5 cm or about
2 inches across) tumors of the arms or legs may be treated with surgery alone. Radiation
therapy may be given after surgery if the tissue removed showed positive or close margins.
Positive margins mean that sarcoma cells were growing into the edges of the tissue that was
removed. Close margins means that the cancer was found close to the edges of the tissue
removed. Either of these can mean that some cancer was left behind and that the cancer may
grow back.
For larger tumors, radiation therapy is sometimes given after surgery to lower the chance that
the cancer will come back.
If the tumor is not in a limb, (for example it is in the head, neck, or abdomen), removing the
entire tumor with enough normal tissue around it can be more difficult. For these tumors,
radiation with or without chemo may be given before surgery. This may be able to shrink the
tumor enough to remove it entirely with surgery. If radiation is not used before surgery, it
may be given after surgery to lessen the chance that the tumor will come back.

Stage II and III soft tissue sarcoma

Some stage III tumors have already spread to nearby lymph nodes. Most stage II and III
sarcomas are high-grade tumors. They tend to grow and spread quickly. Even when these
sarcomas have not yet spread to lymph nodes, the risk of spread (to lymph nodes or distant
sites) is very high. These tumors also tend to grow back in the same area after they are
removed (this is called local recurrence).
For all stage II and III sarcomas, surgically removing the tumor is still the main treatment.
Lymph nodes will be removed as well if they contain cancer. If the tumor is large or in a
place that would make surgery difficult, the patient may be treated with chemo, radiation, or
both before surgery. For large tumors in the arms or legs, giving chemo by isolated limb
perfusion is also an option. The goal of treatment is to shrink the tumor, making it easier to
remove. These treatments also lower the chance of the tumor coming back in or near the
same place it started. Smaller tumors may be treated with surgery first, then radiation to
lower the risk of the tumor coming back. Sometimes chemo is given as well. When chemo is
given, the drug most often used is doxorubicin (Adriamycin). This drug may be combined
with ifosfamide (Ifex) and other drugs.
In rare cases, amputation is needed to remove the entire tumor. As with stage I sarcomas,
radiation therapy with or without chemo can be used alone when the tumor's location or size

or the patient's health in general makes surgery impossible. There is evidence that chemo
after surgery may benefit some people with stage II and III sarcomas.

Stage IV soft tissue sarcoma

A sarcoma is considered stage IV when it has spread to distant sites (M1). Stage IV sarcomas
are rarely curable. But some patients may be cured if the main tumor and all of the
metastases (areas of cancer spread) can be removed by surgery. The best success rate is when
it has spread only to the lungs. This is still an area where doctors disagree about which
patients will benefit. Those patients main tumors should be treated as in stages II or III, and
metastases should be completely removed, if possible.
For patients whose primary tumor and all metastases cannot be completely removed by
surgery, radiation therapy and/or chemotherapy are often given to relieve symptoms. The
chemo drugs doxorubicin and ifosfamide are often the first choice either alone or together
with other drugs. Gemcitabine and docetaxel may be given if the first combination stops
working (or doesn't work). Patients with angiosarcomas may benefit from treatment with
paclitaxel (Taxol) or docetaxel (Taxotere) with vinorelbine (Navelbine).

Recurrent sarcoma
Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or
near the same place it started) or distant (spread to other organs or tissues such as the lungs or
brain). If the sarcoma comes back in the same area where it started, it may be treated with
surgery. Radiation therapy is another option, especially if radiation wasnt part of the
treatment of the original tumor. If external beam radiation was used before, brachytherapy
may still be an option.
If the sarcoma returns at a distant site, chemo may be given. If the sarcoma has spread only to
the lungs, it may be possible to remove all the areas of spread with surgery. Radiation is used
to treat sarcomas that spread to the brain, as well as any recurrences that cause symptoms
such as pain.

More treatment information for soft tissue sarcomas

For more details on treatment options including some that may not be addressed in this
document the National Comprehensive Cancer Network (NCCN) and the National Cancer
Institute (NCI) are good sources of information.
The NCCN, made up of experts from many of the nation's leading cancer centers, develops
cancer treatment guidelines for doctors to use when treating patients. Those are available on
the NCCN Web site (www.nccn.org).

The NCI provides treatment information via telephone (1-800-4-CANCER) and its website
(www.cancer.gov). Information for patients as well as more detailed information for cancer
care professionals is also available on www.cancer.gov.
No cancer treatment can be done without consent. People who are capable of making their
own decisions can decide whether they are willing to take any medical treatment, including
any recommended cancer treatments. Your doctor should discuss treatment options with you,
and explain what is likely to happen if you accept or refuse these treatments. For more, you
can read our document Informed Consent.

What should you ask your doctor about soft

tissue sarcomas?
As you cope with cancer and cancer treatment, you need to have honest, open discussions
with your doctor. You should feel comfortable asking any question no matter how small it
might seem. Nurses, social workers, and other members of the treatment team may also be
able to answer many of your questions.
What kind of sarcoma do I have?
How much experience do you have in diagnosing and treating sarcoma?
Has my cancer spread?
What is the stage of my cancer and what does that mean?
What are my treatment choices?
What treatment do you recommend and why?
What risks or side effects are there to the treatments you suggest?
What are the chances my cancer will come back with these treatment plans?
What should I do to be ready for treatment?
Whats my outlook?
In addition to these sample questions, be sure to write down some of your own. For instance,
you might want more information about recovery times so that you can plan your work
schedule. Or you may want to ask about second opinions or about clinical trials for which
you may qualify.

What happens after treatment for soft tissue

sarcomas?
For some people with soft tissue sarcoma, treatment may remove or destroy the cancer.
Completing treatment can be both stressful and exciting. You may be relieved to finish
treatment, but find it hard not to worry about cancer coming back. (When cancer comes back
after treatment, it is called recurrence.) This is a very common concern in people who have
had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer
survivors have learned to live with this uncertainty and are leading full lives. Our document,
Living With Uncertainty: The Fear of Cancer Recurrence, gives more detailed information
on this.
For other people, the cancer may never go away completely. These people may get regular
treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the
cancer in check. Learning to live with cancer that does not go away can be difficult and very
stressful. It has its own type of uncertainty. Our document, When Cancer Doesn't Go Away,
has more about this.

Follow-up care
When treatment ends, your doctors will still want to watch you closely. It is very important to
go to all of your follow-up appointments. During these visits, your doctors will ask questions
about any problems you have and might do exams and lab tests or x-rays and scans to look
for signs of cancer or treatment side effects. Almost any cancer treatment can have side
effects. Some may last for a few weeks to months, but others can last the rest of your life.
This is the time for you to talk to your cancer care team about any changes or problems you
notice and any questions or concerns you have.
It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no
one wants to think about their cancer coming back, this could happen.
Should your cancer come back, our document, When Your Cancer Comes Back: Cancer
Recurrence can give you information to help you manage and cope with this phase of your
treatment.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself seeing a new
doctor who does not know anything about your medical history. It is important that you be
able to give your new doctor the details of your diagnosis and treatment. Gathering these
details soon after treatment may be easier than trying to get them at some point in the future.
Make sure you have the following information handy:

 A copy of your pathology report(s) from any biopsies or surgeries

If you had surgery, a copy of your operative report(s)
If you were hospitalized, a copy of the discharge summary that doctors prepare when a
patient is sent home
If you had radiation, a copy of your radiation treatment summary
If you had chemotherapy (including hormone therapy or targeted therapy), a list of your
drugs, drug doses, and when you took them
Copy of recent imaging studies (such as x-rays, CT scans, and MRI scans) on a DVD
plus the radiology reports.
The doctor may want copies of this information for his records, but always keep copies for
yourself.

Lifestyle changes after having a soft tissue sarcoma

Having cancer and dealing with treatment can be time consuming and emotionally draining,
but it can also be a time to look at your life in new ways. Maybe you are thinking about how
to improve your health over the long term. Some people even begin this process during
cancer treatment.
You can't change the fact that you have had cancer. What you can change is how you live the
rest of your life making choices to help you stay healthy and feel as well as you can. This
can be a time to look at your life in new ways. Maybe you are thinking about how to improve
your health over the long term. Some people even start during cancer treatment.

Making healthier choices

For many people, a diagnosis of cancer helps them focus on their health in ways they might
not have thought much about in the past. Are there things you could do that might make you
healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down
on the alcohol, or give up tobacco. Even things like keeping your stress level under control
may help. Now is a good time to think about making changes that can have positive effects
for the rest of your life. You will feel better and you will also be healthier.
You can start by working on those things that worry you most. Get help with those that are
harder for you. For instance, if you are thinking about quitting smoking and need help, call
the American Cancer Society for information and support. This tobacco cessation and
coaching service can help increase your chances of quitting for good.

Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer
treatment. Treatment may change your sense of taste. Nausea can be a problem. You may not
feel like eating and lose weight when you don't want to. Or you may have gained weight that
you can't seem to lose. All of these things can be very frustrating.
If treatment caused weight changes or eating or taste problems, do the best you can and keep
in mind that these problems usually get better over time. You may find it helps to eat small
portions every 2 to 3 hours until you feel better. You might also want to ask your cancer team
about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with
these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into
place. You may be surprised at the long-term benefits of some simple changes, like
increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight,
eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of
types of cancer, as well as having many other health benefits. For more information, see our
document, Nutrition and Physical Activity During and After Cancer Treatment: Answers to
Common Questions.

Rest, fatigue, and exercise

Extreme tiredness, called fatigue, is very common in people treated for cancer. This is not a
normal tiredness, but a "bone-weary" exhaustion that doesn't get better with rest. For some
people, fatigue lasts a long time after treatment, and can make it hard for them to exercise
and do other things they want to do. But exercise can help reduce fatigue. Studies have
shown that patients who follow an exercise program tailored to their personal needs feel
better physically and emotionally and can cope better, too.
If you were sick and not very active during treatment, it is normal for your fitness,
endurance, and muscle strength to decline. Any plan for physical activity should fit your own
situation. A person who has never exercised will not be able to take on the same amount of
exercise as someone who plays tennis twice a week. If you haven't exercised in a few years,
you will have to start slowly maybe just by taking short walks.
Talk with your health care team before starting anything. Get their opinion about your
exercise plans. Then, try to find an exercise buddy so you're not doing it alone. Having
family or friends involved when starting a new exercise program can give you that extra
boost of support to keep you going when the push just isn't there.
If you are very tired, you will need to balance activity with rest. Sometimes it's really hard
for people to allow themselves to rest when they are used to working all day or taking care of
a household, but this is not the time to push yourself too hard. Listen to your body and rest
when you need to. (For more information on dealing with fatigue, please see Fatigue in
People With Cancer and Anemia in People With Cancer.)

Keep in mind exercise can improve your physical and emotional health.
It improves your cardiovascular (heart and circulation) fitness.
Along with a good diet, it will help you get to and stay at a healthy weight.
It makes your muscles stronger.
It reduces fatigue and helps you have more energy.
It can help lower anxiety and depression.
It can make you feel happier.
It helps you feel better about yourself.
And long term, we know that getting regular physical activity plays a role in helping to lower
the risk of some cancers, as well as having other health benefits.

How does having a soft tissue sarcoma affect your emotional

health?
When treatment ends, you may find yourself overcome with many different emotions. This
happens to a lot of people. You may have been going through so much during treatment that
you could only focus on getting through each day. Now it may feel like a lot of other issues
are catching up with you.
You may find yourself thinking about death and dying. Or maybe you're more aware of the
effect the cancer has on your family, friends, and career. You may take a new look at your
relationship with those around you. Unexpected issues may also cause concern. For instance,
as you feel better and have fewer doctor visits, you will see your health care team less often
and have more time on your hands. These changes can make some people anxious.
Almost everyone who has been through cancer can benefit from getting some type of
support. You need people you can turn to for strength and comfort. Support can come in
many forms: family, friends, cancer support groups, church or spiritual groups, online
support communities, or one-on-one counselors. What's best for you depends on your
situation and personality. Some people feel safe in peer-support groups or education groups.
Others would rather talk in an informal setting, such as church. Others may feel more at ease
talking one-on-one with a trusted friend or counselor. Whatever your source of strength or
comfort, make sure you have a place to go with your concerns.
The cancer journey can feel very lonely. It is not necessary or good for you to try to deal with
everything on your own. And your friends and family may feel shut out if you do not include
them. Let them in, and let in anyone else who you feel may help. If you arent sure who can
help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch
with a group or resource that may work for you. You can also read more about the emotional

issues common to people with cancer in our booklet, Distress in People With Cancer, which
can be ordered from our toll-free number at no cost to you.

If treatment for soft tissue sarcoma stops

working
If cancer keeps growing or comes back after one kind of treatment, it is possible that another
treatment plan might still cure the cancer, or at least shrink it enough to help you live longer
and feel better. But when a person has tried many different treatments and has not gotten any
better, the cancer tends to become resistant to all treatment. If this happens, it's important to
weigh the possible limited benefits of a new treatment against the possible downsides.
Everyone has their own way of looking at this.
This is likely to be the hardest part of your battle with cancer when you have been through
many medical treatments and nothing's working anymore. Your doctor may offer you new
options, but at some point you may need to consider that treatment is not likely to improve
your health or change your outcome or survival.
If you want to continue to get treatment for as long as you can, you need to think about the
odds of treatment having any benefit and how this compares to the possible risks and side
effects. In many cases, your doctor can estimate how likely it is the cancer will respond to
treatment you are considering. For instance, the doctor may say that more chemo or radiation
might have about a 1% chance of working. Some people are still tempted to try this. But it is
important to think about and understand your reasons for choosing this plan.
No matter what you decide to do, you need to feel as good as you can. Make sure you are
asking for and getting treatment for any symptoms you might have, such as nausea or pain.
This type of treatment is called palliative care.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given
along with cancer treatment, or can even be cancer treatment. The difference is its purpose
the main purpose of palliative care is to improve the quality of your life, or help you feel as
good as you can for as long as you can. Sometimes this means using drugs to help with
symptoms like pain or nausea. Sometimes, though, the treatments used to control your
symptoms are the same as those used to treat cancer. For instance, radiation might be used to
help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be
used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as
treatment to try to cure the cancer. You can learn more about the changes that occur when
curative treatment stops working, and about planning ahead for yourself and your family, in
our documents called Nearing the End of Life and Advance Directives. You can read them
online or call us to have free copies mailed to you.
At some point, you may benefit from hospice care. This is special care that treats the person
rather than the disease; it focuses on quality rather than length of life. Most of the time, it is

given at home. Your cancer may be causing problems that need to be managed, and hospice
focuses on your comfort. You should know that while getting hospice care often means the
end of treatments such as chemo and radiation, it doesn't mean you can't have treatment for
the problems caused by your cancer or other health conditions. In hospice the focus of your
care is on living life as fully as possible and feeling as well as you can at this difficult time.
You can learn more in our document called Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still
hope for good times with family and friends times that are filled with happiness and
meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the
most important things in your life. Now is the time to do some things you've always wanted
to do and to stop doing the things you no longer want to do. Though the cancer may be
beyond your control, there are still choices you can make.

What's new in soft tissue sarcoma research

and treatment?
Research is ongoing in the area of soft tissue sarcomas. Scientists are learning more about
causes and ways to prevent sarcomas, and doctors are working to improve treatments.

Basic research
Scientists have made progress in understanding how certain changes in the DNA of soft
tissue cells cause sarcomas to develop. This information is already being applied to new tests
to diagnose and classify sarcomas. This is important because accurate classification helps
doctors select the most appropriate treatment. It is hoped that this information will soon lead
to new strategies for treating these cancers, based on specific differences between normal and
malignant soft tissue cells.

Classification
Classification of most cancers, including sarcomas, is based mostly on the way they look
under a microscope. Recent research has shown that several different kinds of soft tissue
sarcomas can look very similar under the microscope. By using new lab methods, researchers
discovered that most cancers that used to be called malignant fibrous histiocytoma (MFH)
are actually high-grade forms of liposarcoma, rhabdomyosarcoma, leiomyosarcoma, other
sarcomas, and even carcinomas or lymphomas. About 10% to15% of cancers called MFH
before, still cannot be given a precise classification, and these are now called pleomorphic
undifferentiated sarcomas or undifferentiated pleomorphic sarcomas (although the current
classification system of the World health Organization permits use of MFH as an alternate
name).

Chemotherapy
Active research in chemotherapy for soft tissue sarcomas includes studies of new drugs and
new ways to give drugs now available.
A new drug called trabectedin (Yondelis) has been shown to help some patients with soft
tissue sarcomas. It is approved for use in Europe, but it is still being tested in the United
States. In this country, it is currently only available as part of a clinical trial.

Targeted therapy
Even more active than research into chemotherapy is research into so-called targeted drugs.
These are drugs that specifically block molecules in the cancer cells that cause the cancers to
grow.
Other targeted drugs may also be helpful against sarcomas. For example, the targeted drug
sunitinib (Sutent) seems to slow the growth of many sarcomas. Sirolimus (Rapamune) has
shown some promise in treating patients with PEComa, especially pulmonary
lymphangioleiomyomatosis. Other drugs being studied include cixutumumab, PD0332991,
and ridaforolimus.

Anti-angiogenesis drugs
Drugs that block new blood vessel formation may help kill sarcomas by preventing their
nourishment by the blood vessels. One such drug, bevacizumab (Avastin) has shown a
small benefit in sarcoma patients, when given with doxorubicin (Adriamycin). Cediranib is a
newer anti-angiogenesis drug that shows promise in treating a certain kind of soft tissue
sarcoma.

Additional resources for soft tissue sarcoma

More information from your American Cancer Society
Here is more information you might find helpful. You also can order free copies of our
documents from our toll-free number, 1-800-227-2345, or read them on our website,
www.cancer.org.

Living with Cancer

After Diagnosis: A Guide for Patients and Families (also available in Spanish)
Distress in People With Cancer

Talking With Friends and Relatives About Your Cancer (also in Spanish)
Helping Children When a Family Member Has Cancer: Dealing With Diagnosis (also
available in Spanish)
Caring for the Patient With Cancer at Home: A Guide for Patients and Families (also
available in Spanish)
Guide to Controlling Cancer Pain (also available in Spanish)
Genetic Testing: What You Need to Know
When Cancer Doesnt Go Away

Understanding cancer treatments

Understanding Surgery: A Guide for Patients and Families (also available in Spanish)
A Guide to Chemotherapy (also available in Spanish)
Understanding Radiation Therapy: A Guide for Patients and Families (also available in
Spanish)

Cancer treatment side effects

Fatigue in People With Cancer
Nausea and Vomiting
Anemia in People With Cancer
Peripheral Neuropathy Caused by Chemotherapy

Work, insurance, and finances

Health Insurance and Financial Assistance for the Cancer Patient
Returning to Work After Cancer Treatment
Working During Cancer Treatment

When cancer cant be cured, or if it comes back

When Your Cancer Comes Back: Cancer Recurrence
Advance Directives
Nearing the End of Life

Hospice Care
Your American Cancer Society also has books that you might find helpful. Call us at 1-800227-2345 or visit our bookstore online at cancer.org/bookstore to find out about costs or to
place an order.

National organizations and websites*

In addition to the American Cancer Society, other sources of patient information and support
include:
National Cancer Institute
Toll-free number: 1-800-4-CANCER or 1-800-422-6237; TTY: 1-800-332-8615
Website: www.cancer.gov
Offers current information about many types of cancer and treatments, as well as
guidance for the family and children of people with cancer
The Sarcoma Alliance
Telephone number: 1-415-381-7236
Website: www.sarcomaalliance.org
Information about sarcoma, as well as a discussion board (for those who register non
the website)
*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and
support. Call us at 1-800-227-2345 or visit www.cancer.org.

References: Soft tissue sarcoma detailed

guide
American Cancer Society. Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer
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American Joint Committee on Cancer. Soft tissue sarcoma. In: American Joint Committee on
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Bhangu A, Broom L, Nepogodiev D, Gourevitch D, Desai A. Outcomes of isolated limb
perfusion in the treatment of extremity soft tissue sarcoma: a systematic review. Eur J Surg
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Benjamin R, Pisters PWT, Helman LJ, et al. Sarcomas of soft tissue. In: Abeloff MD,
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Philadelphia, PA. Elsevier: 2008: 2009-2056.

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Chugh R, Wathen JK, Patel SR, et al. Efficacy of imatinib in aggressive fibromatosis: Results
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Clark MA, Fisher C, Judson I, et al. Soft-tissue sarcomas in adults. New Engl J Med.
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Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94109.
Dei Tos AP. Classification of pleomorphic sarcomas: where are we now? Histopathology.
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Demetri GD, Chawla SP, Ray-Coquard I, et al. Results of an international randomized phase
III trial of the mammalian target of rapamycin inhibitor ridaforolimus versus placebo to
control metastatic sarcomas in patients after benefit from prior chemotherapy. J Clin Oncol.
2013 Jul 1;31(19):2485-92. Epub 2013 May 28.
Dickson MA, Tap WD, Keohan ML, et al. Phase II trial of the CDK4 inhibitor PD0332991 in
patients with advanced CDK4-amplified well-differentiated or dedifferentiated liposarcoma.
J Clin Oncol. 2013 Jun1;31(16):2024-20248. Epub 2013 Apr 8.
George S, Merriam P, Maki RG, et al. Multicenter phase II trial of sunitinib in the treatment
of nongastrointestinal stromal tumor sarcomas. J Clin Oncol. 2009 Jul 1;27(19):31543160.
Epub 2009 May 18.
Kummar S, Allen D, Monks A, et al. Cediranib for metastatic alveolar soft part sarcoma. J
Clin Oncol. 2013 Jun 20;31(18):2296-2302. Epub 2013 Apr 29.
Le Cesne A, Domont J, Cioffi A, et al. Mapping the literature: role of trabectedin as a new
chemotherapy option in advanced pretreated soft tissue sarcoma. Drugs Today (Barc).
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Last Medical Review: 10/21/2013
Last Revised: 2/6/2014
2013 Copyright American Cancer Society